Should Medical Schools Do More in Teaching Chronic Pain?

Improving training for medical school students about treating pain is needed.

Dr. Dan Bennett, Chairman of the National Pain Foundation, believes that doctors understanding the cause of pain should be aggressively taught in school

He was responding to a news story that four medical schools in Massachusetts are teaming up to improve training for doctors in pain management with the goal of curbing over-prescription of opioid medications.

Dr. Dan Bennett

“While it is wise to ensure that medical students understand the vagaries of prescribing narcotic pain medications, this can only be accomplished successfully if one starts by educating these students in the complexities of pain itself,” Dr. Bennett told the National Pain Report.

The deans of Harvard Medical School, Boston University School of Medicine, Tufts School of Medicine and the University of Massachusetts Medical School discussed the efforts with Governor Charlie Baker last week.

According to an AP story, the schools say they’ll work together to review current curricula for medical students on safe prescribing.

“I applaud the efforts of Governor Baker,” said Dr. Bennett. “I hope the academicians charged with this task appreciate the much broader problem–the lack of education of the physician regarding pain and its related disease.”

Dr. Bennett is also a practicing interventional spine/pain medicine physician from Denver, Colorado. He believes focusing only on the prescription drug issue is short sighted.

“Any treatment without the understanding of the disease itself and in whom that disease resides is bad medicine. The putting the cart before the horse is what has led to the serious problem of narcotic over-prescribing in the United States.”

The National Pain Foundation has launched the Global Pain Initiative specifically for the purpose of understanding pain and the effects the disease has on populations of people. As the effort gathers data, the plan is to drive the conversation to establish a formal residency in pain.

Bennett has been pressing the case for several years for more educational opportunities about pain in medical school.

“How doctors understand pain and the disease of pain is the lattice needed to determine what treatment is necessary,” he added.

As someone responsible for convincing legislator to introduce 3 pieces of legislation in NYS to require education in pain care- I no longer believe the education that doctors would receive will make much of a difference in treating chronic or acute pain.
It is likely pain specialists whose, National Pain Strategy was subject to 8 criticisms by the IASP, would likely try to indoctrinate doctors with their “biopsychosocial” paradigm. This paradigm is underresearched and unproven. But even if it showed better results than treatment as usual, it would not free or encourage doctors to go beyond the limits of their predecessors in pain care. Moreover, doctors would develop a false sense of familiarity and completion when it comes to chronic pain; forbidding evolution. In addittion, doctors would be taught that chronic pain is incurable and that they should focus on outcome measures like PROMIS-which are impersonal and depersonalizing. With regard to opioids- if medicine had a fair understanding of what they do and dont do with regards to chronic pain- I dont think they would be so focused on their use. Moreover, educating doctors and others on opioids has convinced doctors that pain care is mostly about whether to use or not use opioids. Its tragic, how proponents of pain care education have used such to promote opioids rather than a more varied and full approach to treating pain.
The leadership in medical education is regressive and pays tribute to past ways- ways that have been proven to be woefully inadequate in helping people with chronic pain. Why should society support indoctrination in woefully inadequate ways? Wheres the blue ocean strategy in pain care and pain care education? Like Jefferson, I am more focused on the dreams of the future then the ways of the past-and so I can not support regressive pain care education that will not make pain car emuch different or better than it currently is.
Instead of “educate” doctors other solutions are possible- government and industry supported contests for much more effective treatments-and curative treatments, novel approaches to pain care, reward and study the most successful practitioners-and those successful in overcoming their own pain.
Education in pain care requires good leadership and good followership-current plans for education in pain care are lacking in both. And there are so many other alternatives to move pain care forward then to pay tribute to the ineffective ways of the past and present. Let those experts dream boldly of much different and better pain care first before deciding what others should learn about pain care.

I applaud Dr. Bennett for what he did for his state. I have a genetic disease and have a pain level of 5-6 on the pain scale and that is tolerable for me because I’m used to living with chronic pain. But if my pain goes over that 6 then it spikes to a 10 in a matter of minutes and when none of my home remedies or pain meds work, I just suffer at home because it’s not worth going to the ER if you are a patient with chronic pain. You will get maybe Dilaudid 1mg per hour, which is not enough for those of us with chronic pain, and maybe a shot of steroids and they ship you out the door.
People who live with chronic pain need help immensely but there is nothing out there. Our Pain Dr’s are scared to prescribe the dosages of pain meds we need because of the FDA crackdown and having Dr’s pay a fee every year to have a license to pass out narcotics. So Pain Dr’s are turning to “alternative” methods such as PT, water therapy, biofeedback etc. For a patient like me, I can’t do any of that. PT would make my body worse and my nerve sensitivity is out of control and water hurts my skin.
Chronic pain patients are not looking for a high like an addict. Yes, we become dependent on our meds, but we take then as prescribed.
I’m actually calling our 2 Medical Schools here in Omaha, NE and I’m going to ask if I can do presentations to students about my genetic disease because it affects every body system. Dr’s need to start thinking outside the box instead of being so closed minded and not willing to do their research!

Let’s hope, when teaching this new generation of doctors, the crucial elements of cost and accessibility are factored in. All the new treatments in the world are worthless if a patient has been forced out of the workplace because of disability and thus cannot afford expensive treatments or is unable to get to multiple locations. Instead of drawing a line in the sand and saying a patient must have a series of procedures before receiving any further treatment, doctors need to take into account what the patient can afford and what mobility and transportation issues may limit their participation. These are real world problems, and it seems most doctors are just oblivious to them. Insurance companies, too, should consider the cost savings to them if they, say, paid more for physical therapy or alternative therapies, allowing a patient access to treatment that could not only alleviate their pain, but also improve their health overall.